Device for connecting body tissues

ABSTRACT

A device for connecting body tissues has a head part, which can be pushed into a body opening and has a longitudinal axis, wherein tissue staples are accommodated in the head part in a storage position. The tissue staples have a linear main section and two engagement sections projecting perpendicularly therefrom aligned in a first plane perpendicular to the longitudinal axis. Optimal usability in the human body is achieved by rotor elements, which are pivotable about an axis parallel to the main sections of the tissue staples with each have a bearing surface for an engagement section of a tissue staple to rotate said tissue staple from the storage position into a working position in which the tissue staple is arranged in a further plane oriented perpendicularly to the first plane, and in that a slider is provided to advance the tissue staple and deform it into a clamping position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a national stage filing based upon International PCTApplication No. PCT/AT2017/060264, filed 17 Oct. 2017, which claims thebenefit of priority to Austria application No. A 50932/2016, filed 17Oct. 2016.

BACKGROUND

The present invention relates to a device for connecting body tissues,having a head part with a longitudinal axis which can be pushed into abody orifice, wherein, in the head part, a plurality of tissue staplesare accommodated in a storage position, which consist of a linear mainsection and two engaging sections projecting perpendicularly therefromand which are each aligned in a first plane which is substantiallyperpendicular to the longitudinal axis.

It is known in medicine to close wounds with tissue staples, which areinserted into the skin in the area of the wound edges and then deformedin order to fix the wound edges against each other. Devices have beendeveloped to carry out this process, which are generally referred to asstaplers. Such devices are described in U.S. Pat. No. 5,170,926 A, EP 1695 668 A or EP0 354 724 B, for example. Typically, several tissuestaples are stacked in a magazine, similar to paper staples. Before use,the foremost tissue staple is turned into a position in which it can beadvanced and inserted into the skin.

The present invention relates to devices suitable for connectingsections of body tissue of the type described above, with thedifference, however, that the device is sufficiently small and compactto be inserted into artificial or natural body orifices in order toconnect body tissue inside the body. It therefore relates to the use inendoscopic or laparoscopic interventions. The particular requirement istherefore to design the device with the smallest possible cross-section,to safely apply the necessary actuating forces and to guarantee a highlevel of reliability, since direct visual and tactile control is notpossible in this form of application.

Various devices for connecting body tissues inside the body have becomeknown. However, these devices are complex to use and often only suitablefor special applications.

SUMMARY OF THE INVENTION

It is the object of the present invention to create a simple andeasy-to-use device that can be used to connect body tissue inside thebody.

In accordance with the invention, two rotor elements are provided whichare pivotable about an axis parallel to the main sections of the tissuestaples and which each have a bearing surface for an engagement sectionof a tissue staple in order to rotate the said tissue staple from thestorage position into an operating position in which the tissue stapleis arranged in a further plane which is oriented substantiallyperpendicularly to the first plane, and a slider is provided in order toadvance the tissue staple present in the operating position in thefurther plane and to deform it into a clamping position.

It is an essential aspect of this invention that the individual tissuestaples are actively rotated by rotor elements from the plane in whichthey are stacked in the magazine (storage position) to the plane inwhich they are advanced to penetrate the body tissue (working position).

The rotation takes place about an axis, which is perpendicular to thelongitudinal axis of the device and to the feed direction of the tissuestaples.

A further important aspect of this invention is that a slider assumesthe task of advancing a tissue staple as well as the task of deformingit after penetrating the body tissue in order to establish a secureconnection. In this way, the number of components required can be keptto a minimum and the device can be designed to be particularly compact.

It is advantageous if a rotor spring acts on one rotor element in eachcase in order to make its movement latchable in two rotationalpositions, and that the rotor elements are preferably connected to ashaft. In this way it is possible to make the drive of the rotorelements simple and provide it with sufficient tolerances, since theexact angular position of the rotor elements in the critical positions,i.e. the reception and delivery of the tissue staples, is guaranteed bythe latching.

A particularly elegant way of ensuring the feed of the tissue staples inthe magazine and the necessary contact force on the rotor elements is topretension the tissue staples in the storage position against the rotorelement by at least one storage spring via a storage slider, wherein thestorage spring preferably is attached to the shaft of the rotorelements. The storage spring is a leaf spring which is pretensioned intothe wound position. It always strives to shorten the linear sectionparallel to the magazine and wind itself around the shaft. Theparticular advantage of this solution is that the force applied to thestorage slider is independent of the position of the storage slider,i.e. said force remains essentially the same from the first to the lasttissue staple.

A particularly high degree of compactness can be achieved by the rotorelements being driven by at least one connecting rod, which isarticulated to them and which is preferably connected to the slider viaa connecting slider. In this way, it is possible to drive both theslider and the rotor elements with a single drive element, thuseliminating the need for additional effort for any synchronization ofdifferent drive elements.

It is particularly advantageous in this context if the rotor elementsare each driven by a connecting rod and preferably each connected to theslider by a connecting slider. This ensures symmetrical forceapplication.

An optimum sequence of the individual movements is achieved inparticular in that the connecting slide(s) is/are firmly connected tothe slider and that an elongated hole is arranged at each connectingslider, in which a pin of the connecting rod engages.

The elongated hole ensures that in a first phase of the forward movementonly the slider is advanced, while the pin of the connecting rod slidesbackwards in the elongated hole of the connecting slider so that theconnecting rod and thus the rotor elements are not moved. This phase iscompleted when the cone has arrived at the rear end of the elongatedhole. In a second phase of the forward movement, the connecting slidernow takes the connecting rod with it and in this way causes the rotorelements to rotate.

During the backward motion, at first only one movement of the slider canbe observed in an analogous manner, while the pin of connecting sliderglides ahead within the elongated hole, so that here too no movement ofthe connecting rod and rotor elements occurs. Only when the pin is incontact with the front end of the elongated hole will the connecting rodbe entrained and the rotor elements are turned back.

A particularly preferred embodiment variant of the present inventionprovides that a slider is movably arranged on the side of the mainsections of the tissue staples facing away from the engagement sectionsin the direction of the longitudinal axis, which slider has two lateralfeed regions at its front end face, between which a substantiallyrectangular recess is provided, and that a retaining element is providedwhich engages in the recess of the slider in order to deform the linearmain section of an interposed tissue staple when the slider is advanced.

It is an important aspect of this invention that the slider can bothfeed the tissue staples and deform them in a single movement. It isadvantageous that the force on the respective tissue staple is exerteddirectly in the area of the engagement elements during the feed so thatthese can be advanced against the resistance of the body tissue withoutfirst causing a deformation of the tissue staple. Only when the tissuestaple has penetrated sufficiently deeply into the body tissue does themiddle section of the main section of the tissue staple come intocontact with the retaining element, so that the tissue staple is bentaround the edges of the retaining element.

After the tissue staple has been properly placed in the body tissue, asafe detachment from the device according to the invention must beensured. In accordance with a preferred embodiment variant of thepresent invention, this is achieved by arranging an ejection spring insuch a way that it removes a deformed tissue staple from the retainingelement. A particular advantage of this solution is that the tissuestaple is stripped fully automatically, without any special controleffort.

Stripping is achieved in a particularly simple way in that the ejectionspring protrudes into the movement area of the slider in a force-freestate. By pushing the slider forward, the ejection spring ispretensioned and by pulling the slider back, the spring is released tostrip off the tissue staple.

A particularly safe guidance of the tissue staple can be achieved byproviding a lug on the slider which supports the tissue staple to beadvanced against the pretension of the ejection spring.

An optimal configuration of the tissue staple in the applied state isachieved in that the recess is essentially rectangular.

A particularly compact and space-saving design of the device accordingto the invention can be achieved in that the slider is formed in aplate-shaped manner and the range of movement of the slider lies in aplane which lies in the storage position in the region of the tips ofthe engagement sections of the tissue staples, and particularlypreferably lies substantially parallel and at a constant distance fromthe main sections of the tissue staples in the storage position. In thisway it is possible that the slider and other components used to drivethe slider use the space that is defined by the tissue staples in thestorage position in the magazine.

A particularly efficient operation of the device is achieved in that theslider has a front position and a rear position, wherein in the frontposition a deformed tissue staple is clamped between the slider and theretaining element, and in the rear position a tissue staple rotated fromthe storage position to a working position perpendicular thereto isreceivable.

An important aspect of the present invention is provided in particularthat a hydraulic cylinder and/or a piston rod are arranged at leastpartially inside the space between the engagement sections of the tissuestaples in the storage position, and preferably that the piston rod isfixedly connected to the slider.

The hydraulic drive via a hydraulic cylinder, which enables thenecessary forces to be applied independently of the distance to anoperating element, is essential here. Since the tissue staples partiallysurround the hydraulic cylinder or the piston rod in the storageposition, a special level of space saving is achieved.

In particular, the device can be made particularly compact in that thehydraulic cylinder is formed in a double-acting manner.

A particularly favored embodiment variant of the invention provides atleast one channel for accommodating an instrument. Such known holdinginstruments can be advantageously used to hold tissue or to manipulateits position in order to be able to use the tissue staples optimally.

Preferably, two channels are provided, which preferably diverge slightlytowards the front, wherein the angle between the channels isparticularly controllable. This allows more distant tissue to be pulledup appropriately.

In particular, the manipulation of body tissue can be made particularlyflexible if the holding instruments can be controlled independently ofeach other.

A particularly compact construction of the device according to theinvention can be achieved in particular in that the channel ispreferably arranged adjacent to the hydraulic cylinder and/or that thechannel is arranged between the side parts.

It is particularly advantageous if the channel is located in theproximal area of the head part. This leaves space underneath the tissuestaples in their storage position, so that the holding instruments canbe pushed forward from the divergent channels to the side, even outsidethe cross-section of the device, in order to be able to also grasplateral areas of the body tissue and pull them into the area of thetissue staples.

BRIEF DESCRIPTION OF THE DRAWINGS

In the following, embodiment examples of the present invention will beexplained in more detail using the attached figures, wherein:

FIG. 1 shows a first embodiment variant of a device according to theinvention in a view from below;

FIG. 2 shows the device of FIG. 1 in a side view;

FIG. 3 shows the device of FIG. 1 and FIG. 2 in one in a view fromabove;

FIG. 4 shows the device from FIG. 1 to FIG. 3 in one in a front view;

FIG. 5 shows the device from FIG. 1 to FIG. 4 in an exploded view;

FIG. 6 to FIG. 9 show longitudinal sections at different stages ofmovement to explain the function of the device;

FIG. 10 and FIG. 11 show different diagonal views of a first embodimentvariant of the rotor element;

FIG. 12 and FIG. 13 show different oblique views of a second embodimentvariant of the rotor element;

FIG. 14 shows a further embodiment variant of a device according to theinvention in a longitudinal section;

FIG. 15 and FIG. 16 show two alternative application possibilities ofthe device each in a diagonal view;

FIG. 17 and FIG. 18 each show a longitudinal section of a furtherembodiment variant of the invention in two different positions; and

FIG. 19 shows a cross-section through the embodiment variant of FIG. 17and FIG. 18,

FIG. 20 shows a view of the embodiment variant from FIG. 17 to FIG. 19from below.

DETAILED DESCRIPTION

FIG. 1 to FIG. 5 show the head part 100 of a device according to theinvention, which can eject and deform a tissue staple 1 with a linearmain section 2 and two parallel engagement sections 3 (visible in FIG.5) projecting vertically from it.

The device has a support element 4 on which two side parts 5, ahydraulic cylinder 6 with a cylinder rod 10 and a retaining element 22are arranged. On support element 4, tissue staples 1 with theirengagement sections 3 rest in a storage position 7, which is partiallyillustrated in FIG. 2.

The side parts 5 each have a recess 39, the main part of which isrectangular and is intended to receive the engagement sections 3 of thetissue staples 1 in the storage position 7 and to guide them up anddown. In addition, the respective rotor element 9 is accommodated in therecess 39.

In storage position 7, the tissue staples 1 are essentially stacked ontop of each other, wherein the planes 7 a, in which the main section 2and the engagement sections 3 are located, are parallel to each other.In addition, the planes 7 a are essentially perpendicular to the axis 6a of the hydraulic cylinder 6, which is also the longitudinal axis ofthe device. This enables the tissue staples 1 to be arranged in storageposition 7 in such a way that the space formed between the engagementsections 3 of the tissue staples 1 in storage position 7 can at leastpartially contain the hydraulic cylinder 6 or the cylinder rod 10. Thisenables a very compact and space-saving design.

The tissue staples 1 in storage position 7 are pressed by a storageslider 8 against two rotor elements 9 which are connected to a shaft 12.The pretension required for this is generated by two storage springs 11.These are designed as unwound spiral springs, one end each is attachedto the shaft 12, the other ends to the storage slider 8.

Each of the two rotor elements 9 is rotatably mounted and has a bearingsurface 13 with a support lug 16 for an engagement section 3 of a tissuestaple 1 and a recess 14. A rotor spring 15 can engage in the recess 14to allow latching to define positions of the rotor elements 9. The rotorspring 15 is designed as an extension of the side part 5.

A slider 17 is attached to the cylinder rod 10 and has two feed regions19 with lugs 18. There is a central rectangular recess 20 between thefeed regions 19. The slider 17 can be moved along the longitudinal axis6 a via the hydraulic cylinder 6.

In a first orientation of the rotor elements 9, the bearing surfaces 13face in the direction of the tissue staples 1 in storage position 7. Thestorage slider 8 presses in this case a first tissue staple 1 againstthe bearing surfaces 13. Now the rotor elements 9 can be turned by about90°. The tissue staple 1 resting thereon is co-rotated by the supportlugs 16 to reach a working position 29, in which it is arranged in afurther plane 29 a, which is parallel to the longitudinal axis 6 a.During the first part of the rotation, the first tissue staple 1 ispressed against the bearing surfaces 13 by the storage slider 8, duringthe second part of the rotation, the surface pressure is maintained bythe rotor spring 15 in order to hold the first tissue staple 1 in adefined position. The hydraulic cylinder 6 is at this time in aretracted position, the slider 17 is therefore behind the main section 2of the first tissue staple 1.

Now the hydraulic cylinder 6 can be extended. The slider 17 takes thefirst tissue staple 1 with it. The position on slider 17 is secured byan ejection spring 21 pressing the first tissue staple 1 against the lug18. At the same time, the ejection springs 21 are increasinglypretensioned by the feed.

The first tissue staple 1 is now pressed against the retaining element22, which is centered and adapted to the width of the recess 20 of theslider 17. This deforms the first tissue staple 1 on the main section 2into a rectangle.

When the hydraulic cylinder 6 is subsequently retracted, the pretensionof the ejection spring 21 is transferred to the first tissue staple 1and thus stripped off by the retaining element 22.

The rotor elements 9 are each rotated by a connecting rod 23 articulatedto them, which has a first pin 30, which engages in an eccentric bore 31of the respective rotor element 9. One connecting slider 24 eachconnected to slider 17 has an elongated hole 25 in which a second pin 26of the connecting rod 23 engages. The connection in an elongated hole 25ensures that the rotation of the rotor elements 9 takes place in asecond phase of the movement of the slider 17.

In the following, the other components of the device according to theinvention are briefly explained:

Cover plates 32 are fitted laterally outside the side parts 5 to covertheir recesses 33. The cylinder rod 10 is sealed by seals 34 against thehydraulic cylinder 6, which is fastened to the support element 4 bymounting elements 35. Hydraulic connections 36 and 37 are used to supplythe hydraulic medium to control the device. A mounting bracket isdesignated with reference numeral 38.

To illustrate the operation of the device, FIGS. 6 to 9 show the samelongitudinal section in different positions of the hydraulic cylinder 6.

FIG. 6 shows the initial condition with hydraulic cylinder 6 with fullyextended cylinder rod 10. Pin 26 is in the extension-side stop 27 ofelongated hole 25, the bearing surface 13 of the rotor elements 9 isparallel to the longitudinal axis 6 a. The slider 17 is in the fullyextended position in which a tissue staple 1 (not shown here) has justbeen ejected.

Starting from this position, the cylinder rod 10 is retracted, theslider 17 moves to the right in the diagram, the connecting slider 24connected to it also moves with it. In the first part of the extensionprocess, no movement is transmitted to the connecting rod 23, since thepin 26 moves in the direction of the stop 28 on the entry side of theelongated hole 25 of the connecting slider 24. After about half thestroke, the stop 28 on the entry side is reached, and the connecting rod23 is now moved with the slider 17 and the connecting slider 24. In thisway the rotor elements 9 are turned by about a right angle so that afirst tissue staple 1, which lies on the bearing surfaces 13 in thestorage position, is turned from a vertical position in FIG. 6 to ahorizontal position in which it lies in the plane of the slider 17. Thetissue staple 1, which rests on the bearing surfaces 13, is entrained bythe support lugs 16 of the rotor elements 9. Since the slider 17 hasalready retracted behind the rotor elements 9 at this point, themovement path for the tissue staple 1 is free.

The position thus achieved with the cylinder rod 10 fully retracted isshown in FIG. 7. Now the cylinder rod 10 can be extended again from thehydraulic cylinder 6. The slider 17 moves again with the connectingsliders 24 in the direction of the position of FIG. 6. Again initiallyno movement is transmitted to the connecting rods 23, as the pin 26 ispushed in the elongated hole 25 in the direction of the stop 27 on theextension side. When the stop 27 on the extension side is reached, asshown in FIG. 8, the connecting rods 23 move with the cylinder rod 10,whereby the rotor elements 9 are turned back to the position shown inFIG. 6, which corresponds to the position shown in FIG. 10. During theextension movement of the cylinder rod 10, which starts from FIG. 7 andends in FIG. 9, the slider 17 is pushed forward to deform and eject thetissue staple 1 inserted in the phase between FIG. 6 and FIG. 7. In theposition shown in FIG. 9, the rotor elements 9 are again in the positionto receive another tissue staple 1.

When the slider 17 is fed, the ejection springs 21 are pretensioned viathe tissue staple 1 in working position 29, wherein the lugs 18 on theslider 17 support the tissue staple 1 in working position 29 at thebottom, so that the tissue staple 1 is guided on both sides. Whenpulling back the slider 17, the support of the tissue staple 1 frombelow is omitted so that the ejection springs 21 push it downwards andstrip it off from the retaining element 22.

The working cycle can be restarted after reaching the position shown inFIG. 9.

FIG. 10 to FIG. 13 show two different embodiment variants of a rotorelement 9. The first embodiment variant shown in FIG. 10 and FIG. 11corresponds to the rotor element 9 used and shown in the embodimentvariants of FIG. 1 to FIG. 9.

This first embodiment variant has a bearing surface 13, which forms partof a circular segment in relation to circumference 43. A lug 13 a isprovided at one end to entrain the tissue staple 1, which in its storageposition rests with its engagement section 3 against the bearing surface13, when the rotor element 9 is rotated. The bearing surface 13 does notextend over the entire thickness of the rotor element 9. A web 40remains on one side, which guides the engagement section 3 of theadjacent tissue staple 1 laterally. In the region of this web 40, afirst recess 41 is provided and, as viewed from the center of rotorelement 9, a second recess 14 is designed on circumference 43 at a rightangle thereto. The two recesses 41, 14 are used to latch the rotorspring 15 and to determine the end positions of the rotation of therotor element 9. The eccentric bore 31 is used for rotation through theconnecting rod 23. The bore 42 is intended for fitting onto the shaft12.

In the alternative embodiment variant shown in FIG. 12 and FIG. 13, thebearing surface 13 extends over the entire thickness of thecircumference 43. The lateral guidance is assumed by the cover plates32. In addition to the bearing surface 13, a further contact surface 44at right angles to the circumference is preferably provided, againstwhich the tissue staples 1 rest in the storage position 7 when thebearing surface 13 is turned into the ejection position (parallel to thelongitudinal axis 6 a). With this embodiment variant, the engagementsections 3 of the tissue staples 1, which rest against the bearingsurface 13 or the contact surface 44 and are pressed on by the storagesprings 11, define the end positions of the rotation of the rotorelement 9. Therefore, recesses are not required here.

FIG. 14 shows a longitudinal section of an embodiment variant of thedevice according to the invention using the rotor elements 9 of FIG. 12and FIG. 13. This variant largely corresponds to the embodiment variantshown in FIG. 1 to FIG. 9. It can be seen that the engagement section 3of a first tissue staple 1 on the bearing surface 13 is already presentin the working position 29. A further tissue staple 1 with itsengagement section 3 rests on the further contact surface 44 and ispressed against it by the storage slider 8 so that the rotor element 9is fixed in this position in a resilient manner. After ejecting thefirst tissue staple 1, the rotor element 9 is turned back clockwise,wherein the storage slider 8 together with the tissue staples 1 instorage position 7 must first be pushed back against the resistance ofthe storage springs 11 however.

FIG. 14 also shows that the engagement sections 3 of the tissue staples1 in the storage position 7 (a tissue staple 1 is shown with interruptedlines correspondingly) extend upwardly well beyond the lower section ofthe cylinder rod 10, which means that in the extended position thecylinder rod 10 moves within the rectangular space spanned on threesides of the main section 2 and the two engagement sections 3 of thetissue staple 1.

FIG. 15 shows a first variant of the use of a device according to theinvention. The head part 100 is detachably mounted on a standardendoscope 101 with a bent portion 102 and is controlled by hydraulichoses 103 and 104, which are inserted into a body opening parallel tothe endoscope.

FIG. 16 shows an alternative variant of the use of the device accordingto the invention, in which the head part 100 forms the tip of anindependent flexible instrument 105. According to standard designs hasat least one channel through which an endoscope 107 with a bent portion102 can be inserted. The endoscope 107 is led out laterally with aseparate bent portion 106 in order to be able to observe the process ofstapling.

The embodiment variant of FIG. 17 and FIG. 18 differs from the variantsdescribed above in that two channels 50, 51 are provided below thehydraulic cylinder 6. Channels 50, 51 are directed outwards towards thedistal end, i.e. divergent, wherein the angle of divergence ispreferably adjustable. If holding instruments are now pushed through thechannels 50 and 51 forward in each case, then these come out slightlydirected outwards, wherein thus the variable extension increases by thedistance to the point, thus increasing the space underneath the tissuestaples 1 in their storage position 7.

Due to the special design of the device, it is possible to arrange thechannels 50 and 51 within the circular cross-section defined by theother components.

The present invention makes it possible to connect tissues inside thebody with tissue staples, wherein it is particularly advantageous that anumber of tissue staples can be used one after the other without theneed to pull the device out of the patient's body and then reinsert itagain.

The invention claimed is:
 1. A device for connecting body tissues, thedevice comprising: a head part configured and arranged to be extendedinto a body opening, the head part including a longitudinal axis; aplurality of tissue staples accommodated in the head part in a storageposition (7), the tissue staples including a linear main section, andtwo engagement sections projecting perpendicularly from the linear mainsection and each of the two engagement sections are aligned in a firstplane substantially perpendicular to the longitudinal axis; two rotorelements configured and arranged to pivot about an axis parallel to themain sections of the plurality of tissue staples, and each of the rotorelements including a bearing surface configured and arranged to engage arespective engagement section of one of the plurality of tissue staplesin order to rotate said tissue staple from the storage position into anoperating position in which the tissue staple is arranged in a furtherplane which is oriented substantially perpendicularly to the firstplane; and a slider configured and arranged to advance the tissuestaple, which is present in the working position, in the further planeand to deform it into a clamping position about body tissue.
 2. Thedevice according to claim 1, further including a rotor spring configuredand arranged to engage with at least one of the two rotor elements inorder to carry out its movement in two rotational positions so as to belatchable, and wherein the two rotor elements are connected to oneanother by a shaft.
 3. The device according to claim 2, characterized inthat the tissue staples in the storage position are pretensioned againstthe rotor element by at least one storage spring via a storage slider,and wherein the storage spring is fastened to the shaft of the rotorelements.
 4. The device according to claim 1, characterized in that therotor elements are configured and arranged to be driven by at least oneconnecting rod which is articulated to the rotor elements, and the atleast one connecting rod is connected to the slider via a connectingslider.
 5. The device according to claim 1, characterized in that therotor elements are configured and arranged to each be driven by aconnecting rod, and the rotor elements are each connected to the slidervia a connecting slider.
 6. The device according to claim 4,characterized in that the connecting slider is firmly connected to theslider, and each connecting slider includes an elongated hole configuredand arranged to engage with a pin of the connecting rod.
 7. The deviceaccording to claim 1, characterized in that the tissue staples areguided, in the storage position, by recesses in side parts.
 8. Thedevice according to claim 1, characterized in that at least one of thetwo rotor elements has a contact surface which is at a right angle tothe bearing surface.
 9. The device according to claim 1, characterizedin that the slider is arranged on the side of the main section of theplurality of tissue staples, and facing away from the engagementsections so as to be movable in a direction of the longitudinal axis,said slider including two lateral feed regions on its front end face,between which a recess is provided, the recess including a retainingelement configured and arranged to engage in the recess of the slider inorder to deform the linear main section of an interposed tissue staplewhen the slider is advanced.
 10. The device according to claim 9,further including an ejection spring configured and arranged to stripoff a deformed tissue staple from the retaining element.
 11. The deviceaccording to claim 10, characterized in that the ejection spring isfurther configured and arranged to project, in a force-free state, intoa range of movement of the slider.
 12. The device according to claim 10,characterized in that the ejection spring is configured and arranged tobe pretensioned during advance of the slider and transfers thepretension to the tissue staple during a return stroke of the slider.13. The device according to claim 10, further including a lug on theslider, the lug configured and arranged to support the advancing tissuestaple against the pretension of the ejection spring.
 14. The deviceaccording to claim 9, characterized in that the recess is substantiallyrectangular.
 15. The device according to claim 9, characterized in thatthe slider is plate-shaped and the range of movement of the slider liesin the further plane which lies, while in the storage position, in aregion of the tips of the engagement sections of the tissue staples, andfurther lies substantially parallel and at a constant distance from themain sections of the tissue staples.
 16. The device according to claim10, characterized in that the slider includes a front position and arear position, wherein the deformed tissue staple in the front positionis configured and arranged to be clamped between the slider and theretaining element, and a tissue staple in the rear position isconfigured and arranged to be turned from the storage position into aworking position and disposed perpendicular thereto is receivable. 17.The device according to claim 1, wherein at least partially arrangedwithin the space disposed between the engagement sections of the tissuestaples in the storage position is a hydraulic cylinder and/or a pistonrod, and the piston rod is fixedly connected to the slider.
 18. Thedevice according to claim 17, characterized in that the hydrauliccylinder is double-acting.
 19. The device according to claim 1,characterized in that the head part is configured and arranged to beattached to an endoscope.
 20. The device according to claim 17,characterized in that the head part is integrally connected to aflexible instrument including a channel configured and arranged formounting to an endoscope.
 21. The device according to claim 20, furtherincluding at least one channel configured and arranged to receive aholding instrument.
 22. The device according to claim 21, wherein the atleast one channel includes two channels configured and arranged todiverge slightly towards a front of the device, wherein the anglebetween the two channels is controllable.
 23. The device according toclaim 22, wherein the two channels are configured and arranged toreceive more than one holding instrument, and each of the holdinginstruments are controllable independently of one another.
 24. Thedevice according to claim 20, characterized in that the channel isarranged adjacent to the hydraulic cylinder.
 25. The device according toclaim 21, characterized in that the at least one channel is arrangedbetween side parts.
 26. The device according to claim 21, characterizedin that the at least one channel is arranged in a proximal region of thehead part.